Provider Demographics
NPI:1154743763
Name:SUMMIT PHYSICAL THERAPY AND SPORTS CARE, LLC
Entity type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY AND SPORTS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIDERIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-627-0100
Mailing Address - Street 1:160 SUMMIT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1750
Mailing Address - Country:US
Mailing Address - Phone:201-627-0100
Mailing Address - Fax:201-746-6652
Practice Address - Street 1:160 SUMMIT AVE STE 104
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1750
Practice Address - Country:US
Practice Address - Phone:201-627-0100
Practice Address - Fax:201-746-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty